Applied Radiology speaks with Julia Crim, MD, Chief of Musculoskeletal Radiology, University of Utah about managing the various athletic injuries of our olympians.
With 2300 of the world's top athletes competing at the highest
level of competition on either ice or snow, it's a safe bet that
injuries will occur and that prompt, professional medical attention
will be necessary. To address these needs, the Olympic
Organization, in conjunction with the University of Utah, created a
freestanding clinic to provide multiple medical services for
athletes, officials, and family members attending the XIX Olympic
Winter Games in Salt Lake City. The facility, called the
Polyclinic, will provide radiology, general sports medicine,
dental, pharmacy, and laboratory services for the Winter Games and
for the Paralympics immediately following.
(AR) recently spoke with Julia Crim, MD, chief of musculoskeletal
radiology at the University of Utah Hospitals and Clinics and chief
of musculoskeletal imaging at the Polyclinic, and Mary Freeh,
operations manager for the Polyclinic and director of radiology for
the University of Utah.
How long did it take to create the Polyclinic?
Julia Crim, MD:
About a year. The University of Utah has what is called the "Guest
House." The top floors of the building are rooms for people to stay
in and the bottom floor was conference rooms. We designed the
conference room area to be a clinic. We actually did a lot of
construction, such as putting walls in, to turn it into a real
hospital-certified clinic that meets all of the requirements for
any U.S. facility. It is essentially a mini-hospital. It has been
built beautifully. It's strange to realize that all this equipment
has been installed and all this construction has been done and it
will be disassembled at the end of March.
What will happen to it?
At the end of the Paralympics, on March 19, we start taking all the
equipment back out, taking the construction apart, and turning the
space back into the conference center. This has been one of the big
parts of the University of Utah's donation to the clinic. They have
had a full-time team working on nothing but this for about a year--
putting in a tremendous amount of time, money, caring, and
professional expertise--all funded by the University. We have had
no support from the Salt Lake Olympic Committee or the state of
How is the radiology department of the clinic equipped?
We have a donated magnetic resonance imaging system (1.5-Tesla
mobile Signa Infinity system) from GE Medical Systems (Waukesha,
WA), and an ultrasound unit (HDI 5000 SonoCT) from Philips Medical
Systems (Bothell, WA). Eastman Kodak Health Imaging (Rochester,
NY), the major medical imaging sponsor, donated a DirectView DR
9000 digital radiography system, Kodak DirectView DX diagnostic
workstations, a Kodak PACS setup, and a paper printer. Talk
Technology (Bensalem, PA) donated a TalkStationRadiology system to
be used for voice recognition for our reports.
People have supported us with top-of-the-line new, beautiful
equipment. I can't say how grateful we are. Kodak has essentially
given us a full PACS system to be used just for the 2 months, and
they have donated the personnel so that all of the visiting
radiologists can be trained in how to use it and have the support
they need. They trained all our personnel in how to use DR, since
we have not used DR previously at the University.
Is the entire system integrated?
Yes. All three modalities (MRI, ultrasound, and DR) send images
directly into the PACS archives, which then sends them directly out
to the viewing station so that they can be read immediately. We
also are able to send any or all of these images to the University
hospital's archives in case a study needs to be looked at by a
specialist at the hospital. Most of our radiologists at the
Polyclinic are musculoskeletal specialists. Therefore, if we get,
for example, a neurologic case, we may want to consult with someone
in the University. We are also integrated with our radiology
information system in the hospital for scheduling and patient
There are two issues with regard to integration. One is that we
were concerned that this is sensitive information, especially
before the games; so there is very limited access to the
information even though we are using the hospital system.
Information access has been very carefully limited by our chief of
information technology services to make sure that no one could call
in and check on the other athletes. Even physicians at the hospital
cannot do that; you have to have special clearance.
The other issue is that we wanted the athletes to be able to
leave the clinic with a copy of their report and with relevant
images. So, from the PACS, we print key images directly on the
Kodak paper printer, which prints a high-quality image on glossy
paper. When they leave, the athletes have the images and the report
in an envelope that is theirs to take back to their home
How is the radiology department of the Polyclinic staffed?
One of the things that I'm very excited about in the clinic is the
team of radiologists that we have. I thought it would be fun to
have a national team of radiologists, so I went to the Society of
Skeletal Radiology and from my colleagues there, I chose
radiologists from all around the country. There are 10 radiologists
in total. We have two to three shifts a day with two to three
radiologists overlapping. Almost all of the technologists are from
the University of Utah. I was very pleased at how eager people were
to volunteer, to take part, to give of their best. It is very
exciting to have people from a variety of different institutions
with a variety of different viewpoints working together in the
setting of the Olympics.
How many patients have you been seeing a day?
It varies tremendously from day to day. Overall, we have seen more
than 250 patients (by day 14 of the games) and many of those have
had multiple exams. There have been approximately 3,000 clinic
visits in total, but, obviously, a lot of those did not end up in
radiology. We have performed about 350 exams, mostly on athletes,
but some coaches as well.
I have been very pleased with how smoothly it is going. It was
all a new--and temporary--setup, but it has worked very well. We've
been doing everything as we planned: patients come in and leave
with copies of their x-ray report and copies of their film.
Have you had to use the PACS system to consult with the
We had one head injury that required a consultation. Almost
everything has either been musculoskeletal or abdominal imaging. We
had one early pregnancy that required consultation as well.
Has there been anything you haven't been able to do?
No. It has worked great. We have seen most of the crashes that
occurred on the hills, although in cases in which there was concern
about the patient's safety, they have taken the patient directly to
the emergency room instead. We have also been taking the computed
tomography (CT) cases over to the hospital. We predicted that
correctly; we needed the MRI much more than the CT. We've had to
use CT in only three patients. We are also lucky that we have a
top-notch ultrasonographer. He has been handling some of the
non-musculoskeletal, as well as the musculoskeletal exams at a very
high level, using the ultrasound as a CT.
Is there anything else you would like to add?
I would like to emphasize that the athletes have all been very
nice. Sometimes it has been so busy that they have quite a bit of a
wait, but they have been very easy to deal with. They have been
very grateful to get the images and the reports to take back to
their home country. The coaches have been a pleasure. The whole
thing has been far more of a team than I had anticipated that we
would be able to do with doctors from all over the country and all
over the world and athletes from all over the world. It has worked
very, very smoothly.